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Additional information submitted for the record by-Continued
Washington University (St. Louis, Mo.) Social Science Institute:
St. Louis detoxification diagnostic and evaluation center-
Budget and personnel, Dec. 1, 1967-Nov. 30, 1968.
Preliminary evaluation report_

West Virginia Department of Mental Health:
Statement of-

Dr. M. Mitchell-Bateman, director..

Donald R. Dancy, supervisor, division of alcoholism....

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243

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REGIONAL MEDICAL PROGRAMS; ALCOHOLICS AND NARCOTICS ADDICTS FACILITIES: HEALTH SERVICES FOR DOMESTIC AGRICULTURAL MIGRATORY WORKERS

TUESDAY, MARCH 26, 1968

HOUSE OF REPRESENTATIVES,

SUBCOMMITTEE ON PUBLIC HEALTH AND WELFARE,
COMMITTEE ON INTERSTATE AND FOREIGN COMMERCE,
Washington, D.C.

The subcommittee met at 10 a.m., pursuant to notice, in room 2322, Rayburn House Office Building, Hon. Paul G. Rogers presiding (Hon. John Jarman, chairman).

Mr. KYROS (presiding). The subcommittee will please be in order. The hearings today are on H.R. 15758, introduced by Chairman Staggers at the request of the administration.

This bill would extend and expand the existing authorizations for regional medical programs, would extend the program of health services for domestic agricultural migratory workers, and would provide matching grants for construction and staffing of facilities for prevention of alcoholism addiction and for treatment of alcoholics and narcotic addicts.

REGIONAL MEDICAL PROGRAMS

In 1965, the Congress considered legislation proposing the establishment of regional medical programs designed to improve the health care of the American people in the fields of heart disease, cancer, stroke and related diseases. The Congress made substantial revisions in the proposed program, providing in general for a maximum of decentralization of the decisionmaking process and encouraging the maximum feasible cooperation between public and private groups interested in the health of the American people.

It is impossible to give a simple description of a regional medical program since every program established is different, with each program tailored specifically to the needs of the region served.

Over 90 percent of the population of the United States is or will be covered by regional medical programs established on the local level either on an operational basis today or through programs currently in the planning stage. Eventually, 100 percent of our population will be covered by these programs.

Many fears and reservations were expressed at the time the Congress was considering the initial legislation. It is my understanding, however, that many of the groups which had reservations about the initial proposals have since modified their positions, in large measure

(1)

because of the modifications that were made in the program by the Congress and the manner in which the program has been administered to date.

As I understand the bill presented to us, no major changes are proposed. The principal purpose of the legislation is to extend the program beyond its scheduled expiration date of June 30 this year, with minor improvements that experience has shown to be necessary or desirable.

In regard to the section on domestic agricultural migratory workers, the bill also proposes to extend for two additional years the existing program of Federal grants for health services to domestic agricultural migratory workers.

The existing program is also scheduled to expire June 30 this year, so extension is essential at this time if these workers, who are among the neediest today, are to continue to receive the services they need.

ALCOHOLIC AND NARCOTICS ADDICTS

Title II of this bill would establish a program designed to provide assistance in the treatment and rehabilitation of alcoholic and narcotic addicts. The program proposed is an extension of the principles already embodied in the community mental health centers and mental retardation facilities acts approved by this committee in 1963. The bill provides matching grants for construction and operation of facilities which are part of a complex providing essential elements of comprehensive mental health services in order to provide services for the prevention and treatment of alcoholism.

Grants are also authorized for construction and operation of special residential and other facilities for treatment of homeless alcoholics; grants for construction and operation of facilities for prevention and treatment of narcotic addiction; and grants for training and evaluation relating to the prevention and treatment of narcotic addiction.

There are a substantial number of witnesses who have requested the opportunity to be heard on this legislation, which is indicative of the broad public response to the needs which will be served by the enactment of this bill.

We hope to be able to expedite these hearings in order that the legislation may reach the President's desk at the earliest possible date in view of the relatively brief time remaining before two of the programs contained in the bill are scheduled to expire.

The bill under consideration, and agency reports on the bill, will be included in the record at this point.

(The bill, H.R. 15758, and departmental reports thereon, follow :)

[H.R. 15758, 90th Cong., second sess.]

A BILL To amend the Public Health Service Act so as to extend and improve the provisions relating to regional medical programs, to extend the authorization of grants for health of migratory agricultural workers, to provide for specialized facilities for alcoholics and narcotic addicts, and for other purposes

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

TITLE I-REGIONAL MEDICAL PROGRAMS

EXTENSION OF REGIONAL MEDICAL PROGRAMS

SEC. 101. Section 901 (a) of the Public Health Service Act (42 U.S.C. 299a) is amended by striking out "and" before "$200,000,000" and by inserting after

"June 30, 1968," the following: "$65,000,000 for the fiscal year ending June 30, 1969, and such sums as may be necessary for the next four fiscal years,".

EVALUATION OF REGIONAL MEDICAL PROGRAMS

SEC. 102. Section 901 (a) of the Public Health Service Act is further amended by inserting at the end thereof the following new sentence: "For any fiscal year ending after June 30, 1969, such portion of the appropriations pursuant to this section as the Secretary may determine, but not exceeding 1 per centum thereof, shall be available to the Secretary for evaluation (directly or by grants or contracts) of the program authorized by this title."

INCLUSION OF TERRITORIES

SEC. 103. Section 902 (a)(1) of the Public Health Service Act (42 U.S.C. 299b) is amended by inserting after "States" the following: “(which for purposes of this title includes the District of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Trust Territory of the Pacific Islands)".

COMBINATIONS OF REGIONAL MEDICAL PROGRAM AGENCIES

SEC. 104. Section 903 (a) and section 904(a) of the Public Health Service Act (42 U.S.C. 299c, 299d) are each amended by inserting after "other public or nonprofit private agencies and institutions" the following: ", and combinations thereof,".

ADVISORY COUNCIL MEMBERS

SEC. 105. (a) Section 905 (a) of the Public Health Service Act (42 U.S.C. 299e) is amended by striking out "twelve" and inserting in lieu thereof "sixteen".

(b) Section 905(b) of such Act is amended by striking out “and four at the end of the third year" and inserting in lieu thereof "four at the end of the third year, and four at the end of the fourth year".

MULTIPROGRAM SERVICES

SEC. 106. Title IX of the Public Health Service Act is further amended by adding at the end thereof the following new section :

"PROJECT GRANTS FOR MULTIPROGRAM SERVICES

"SEC. 910. Funds appropriated under this title shall also be available for grants to any public or nonprofit private agency or institution for services needed by or which will be of substantial use to, any two or more regional medical programs."

CLARIFYING OR TECHNICAL AMENDMENTS

SEC. 107. (a) Section 901 (c) of the Public Health Service Act is amended by inserting before the period at the end thereof "or, where appropriate, a practicing dentist".

(b) Section 901 of such Act is further amended by adding at the end thereof the following new subsection:

"(d) Grants under this title to any agency or institution for a regional medical program may be used by it to assist in meeting the cost of participation in such program by any Federal hospital."

TITLE II-MIGRATORY WORKERS

EXTENSION OF SPECIAL GRANTS FOR HEALTH OF MIGRATORY WORKERS

SEC. 201. Section 310 of the Public Health Service Act (42 U.S.C. 242h) is amended by striking out "and, $9,000,000 for the fiscal year ending June 30, 1968" and inserting in lieu thereof "$9,000,000 each for the fiscal year ending June 30, 1968, and the next fiscal year, and such sums as may be necessary for the fiscal year ending June 30, 1970".

TITLE III-ALCOHOLIC AND NARCOTIC ADDICT REHABILITATION SEC. 300.This title may be cited as the "Alcholic and Narcotic Addict Rehabilitation Amendments of 1968".

PART A-ALCOHOLIC REHABILITATION

SEC. 301. The Community Mental Health Centers Act (42 U.S.C. 2681, et seq.) is amended by adding after part B the following new part:

"PART C-ALCOHOLISM

"CONSTRUCTION GRANTS

"SEC. 241. (a) Grants from appropriations under section 261 for construction of any facilities may be made only to a public or nonprofit private agency or organization and only upon an application (1) which meets the requirements for approval under clauses (1) through (5) and clause (A) of section 205(a), (2) which is for construction of a facility for the prevention and treatment of alcoholism, and (3) which contains

"(A) a showing of the need, in the area to be served by the applicant, for special facilities for the inpatient or outpatient treatment, or both, of alcoholism;

"(B) satisfactory assurance that the services for prevention and control of alcoholism to be provided through the facility to be constructed, alone or in conjunction with other facilities owned or operated by the applicant or affiliated or associated or having an arrangement with the applicant, will include, or be part of a program providing, principally for persons residing in or near the particular community or communities in which such facility is situated, at least those essential elements of comprehensive mental health services and services for the prevention and treatment of alcoholism, including postinstitutional aftercare and rehabilitation, that are prescribed by the Secretary;

"(C) satisfactory assurance that the application has been approved and recommended by the single State agency designated by the State as being the agency primarily responsible for care and treatment of alcoholics in the State, and, in case this agency is different from the agency designated pursuant to section 204 (a) (1), a showing that the application has also been approved and recommended by the agency designated pursuant to section 204 (a) (1);

"(D) a showing that the project is entitled to priority over other projects for treatment of alcoholism, if any, within the State in accordance with regulations of the Secretary as to general manner of determining priority, and is in accordance with such criteria, including the willingness and ability to provide satisfactory alternatives to custodial care, as the Secretary may determine to be appropriate for purposes of this section; and

"(E) a showing that adequate provision has been made for furnishing needed services for persons unable to pay therefor in accordance with regulations of the Secretary under section 203(4) and for compliance with State standards for operation and maintenance.

"(b) The amount of any such grant with respect to any project shall be such percentage of the cost thereof, but not in excess of 66% per centum, as the Secretary may determine.

"STAFFING, OPERATION, AND MAINTENANCE GRANTS

"SEC. 242. (a) Grants from appropriations under section 261 may be made to any public or nonprofit private agencies and organizations to assist them in projects for the operation, staffing, and maintenance of new facilities for prevention and treatment of alcoholism or of new services in facilities for prevention and treatment thereof.

"(b) Grants under this section may be made only upon an application which meets the requirements for approval under part B. In making such grants, the Secretary shall take into account the relative needs of the several States for alcoholism programs and the relative financial need of the applicants and the relative population of area to be served by the applicants. In the case of any project the application for which is approved under this section, the maximum

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